Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review

Table 4

Effects of banning smoking in public places on smoking initiation, cessation, and prevalence.

Author, year	Country (data source)	Study design	Dates of data collection	Population	Intervention, n	Smoking measure	Effect on smoking initiation, cessation, or prevalence
Smoking initiation
Hawkins et al., 2011 [41]	England, Scotland (MCS)	Longitudinal	2000–2007	Adults; mean age = 29	(I) complete ban, including restaurants and/or bars, 1072; (f) and 632 (m); (C) no smoking ban, 4158 (f) and 2624 (m)	Daily smoking	Initiation rates at followup, females: (I) 6.2%; (C) 7.3%; aOR = 0.75 (95% CI: 0.58; 0.97); Initiation rates at followup, males: (I) 3.6%; (C) 4.5%; aOR = 0.81 (95% CI: 0.48; 1.37)
Klein, 2008 [42]	US (MACC)	Longitudinal	2000–2006	Youths, age 12–16	(I) complete ban in restaurants and/or bars; (C) smoking areas designated or not restricted	Ever smoked at least a whole cigarette	aOR = 1.08 (95% CI: 1.00;, 1.16)
Smoking cessation
Hawkins et al., 2011 [41]	England, Scotland (MCS)	Longitudinal	2000–2007	Adults; Mean age = 29	(I) complete ban, including restaurants and/or bars, 1072; (f) and 632 (m); (C) no smoking ban, 4158 (f) and 2624 (m)	Not smoking any cigarettes	Quit rates within 1 year after ban, females: (I) 16.0%; (C) 24.0%; aOR = 0.65 (95% CI: 0.47; 0.89); Quit rates within 1 year after ban, males: (I) 20.5%; (C) 28.8%; aOR = 0.66 (95% CI: 0.46; 0.93)
Biener et al., 2010 [43]	US (UMass Tobacco Study)	Longitudinal	2001–2006	Adults, age 18+,; Age 18–30: 25%; Age 31–59: 65%; Age 60+: 10%–46% male	(I) change in town’s workplace or restaurant smoking ban, 1162; (C) no change, 1473	3-month abstinence	Quit rates within 2 years after ban: (I) 13.1%; (C) 13.8%; aOR = 0.95 (95% CI: 0.69; 1.31)
Hyland et al., 2009 [44]	UK (ITC)	Longitudinal	2006-2007	Adults, age 18+	(I) complete ban, including restaurants and/or bars, in Scotland, 507; (C) other parts of UK, 828	Smoked at least once/month and smoked at least 100 cigarettes lifetime	Quit rates 1 year after intervention: (I) 19% (95% CI: 9.8; 29%); (C) 21% (95% CI: 14; 28%); aOR = 0.91 (95% CI: 0.47; 1.7)
De Chaisemartin et al., 2011 [50]	France (Consultation Dependance Tabagique)	Longitudinal	2004–2008	Adults	(I) complete ban in workplaces, 5963	Smoked 0 cigarettes/day and all expired CO measures <9 ppm	Mean difference in quit rates between employed and unemployed: 7.0%
Bauza-Amengual et al., 2010 [45]	Spain (original data collection)	Longitudinal	2006-2007	Adults, age 18+	(I) complete ban, including restaurants and/or bars^††	Quit smoking (self-reported)	Quit rates 1 month after ban: 9.5%; Quit rates 6 months after ban: 13.8%
Murphy et al., 2010 [46]	US (original data collection)	Longitudinal	2002–2005	Adults, age 18+,; 20% male,; mean age = 37 years	(I) complete ban, including restaurants and/or bars, 237	Quit smoking	Quit rate 2 years after ban: 14%
Orbell et al., 2009 [47]	England (original data collection)	Longitudinal	2007	Adults, age 18+,; 57% male,; Mean age = 36 years	(I) complete ban, including restaurants and/or bars, 84	Quit smoking	Quit rates 3 months after ban: 15.5%
Martinez-Sanchez et al., 2009 [48]	Spain (original data collection)	Longitudinal	2005-2006	Adults	(I) complete ban, including restaurants and/or bars^††, 118	Daily or occasional smokers with salivary cotinine concentration ≤35 ng/mL per cigarette smoked	Quit rate 1 year after ban: 5.1%
Fowkes et al., 2008 [49]	Scotland (AAA Trial)	Longitudinal	1998–2007	Adults, age 50–75; 33% male; mean age = 60.9	(I) complete ban, including restaurants and/or bars, 1141	Self-reported; must have quit for at least 3 months	Change in smoking cessation pattern during 2006, with increase in quit rates (5.1%) in 3-month period prior to ban
Smoking prevalence
Mackay et al., 2011 [57]	Scotland (Scottish Household Survey)	Time series	1999–2010	NR	(I) complete ban, including restaurants and/or bars	Current smoker	Coeff. for 3–6 mos prior to law: −1.70 (95% CI: −2.38, −1.02), 𝑃<0.001; Coeff. for 9 mos after law: −0.08 (95% CI: −0.39, 0.22); 𝑃=0.59
Wakefield et al., 2008 [27]	Australia (Roy Morgan Single Source)	Time series	1995–2006	Adults, age 18+	(I) complete ban, restaurants only	Smoke factory-made cigarettes	Coeff. (se): −0.0104 (0.0103); 𝑃=0.317
Anger et al., 2011 [63]	Germany (SOEP)	Longitudinal	2002–2008	Adults,; mean age = 47; 47% male	(I) complete ban, including restaurants and/or bars	Current smoker	Coeff.: −0.004 (se: 0.008); 𝑃>0.05
Hawkins et al., 2011 [41]	England; Scotland (MCS)	Longitudinal	2000–2007	Adults,; mean age = 29	(I) complete ban, including restaurants and/or bars, 1522; (f) and 904 (m); (C) no smoking ban, 5954 (f) and 3757 (m)	Daily smoking	Smoking prevalence at baseline, females: (I) 31.0%; (C) 29.8%; Smoking prevalence at followup, females: (I) 30.3%; (C) 27.7%; aOR = 1.15 (95% CI: 0.95; 1.40); Smoking prevalence at baseline, males: (I) 31.5%; (C) 29.5%; Smoking prevalence at followup, males: (I) 27.5%; (C) 24.2%; aOR = 1.24 (95% CI: 0.95; 1.61)
Mullally et al., 2009 [58]	Ireland (All-Ireland Bar Study)	Longitudinal	2004-2005	Adults, age 18+; 71% male; Mean age = 33	(I) complete ban, including restaurants and/or bars	Combined self report and cotinine measures	Smoking prevalence prior to law: 56.1%; Smoking prevalence 1 year after law: 51.4%; 𝑃=0.125
Klein et al., 2009 [54]	US (MACC)	Longitudinal	2000–2006	Youths, age 12–16; 49% male	(I) complete ban in restaurants and/or bars, 1028; (C) smoking areas designated or not restricted, 3205	Smoked in the past month	aOR = 1.06 (95% CI: 0.93; 1.21)
Bitler et al., 2011 [65]	US (TUS-CPS)	Before/after w/comparison	1992–2007	Adults, age 18+	Strength of state smoking bans in bars^§	Daily or someday smoker	OR = 0.78 (95% CI: 0.64 to 0.94)
White et al., 2011 [16]	Australia (cross-sectional surveys of secondary schools)	Before/after w/comparison	1990–2005	Youths, age 12–17	Scoring system based on the extent to which policies have been adopted	Smoked in the past month	aOR = 0.93 (95% CI: 0.92; 0.94)
Hahn et al., 2010 [51]	US	Before/after w/comparison	2004–2008	Youths, age 18–24; 31–39% male	(I) complete smoking ban, including restaurants and/or bars, 897*, 469**; (C) delayed smoking ban, including restaurants and/or bars, 703*, 701**	Smoked in past 30-days	Smoking prevalence (I); before ban: 28.0%; 3.5 years after ban: 19.4%; 𝑃=0.005; Smoking prevalence (C); before ban: 21.5%; 8 months after ban: 16.9%; 𝑃=0.03
Bitler et al., 2010 [66]	US (TUS-CPS)	Before/after w/comparison	1992–2007	Adults, age 18+	Venue-specific Impact Teen ratings	Smoked at least some days	Coeff. for private workplace SCIAL among private sector workers: 0.001 (se: 0.003); 𝑃>0.05; Coeff. for government workplace SCIAL among government workers: 0.011 (se: 0.009); 𝑃>0.05; Coeff. for public school SCIAL among school workers: −0.001 (se: 0.003); 𝑃>0.05; Coeff. for private school SCIAL among school workers: −0.004 (se: 0.004); 𝑃>0.05; Coeff. for restaurant SCIAL among all workers at eating/drinking places: 0.013 (se: 0.014); 𝑃>0.05; Coeff. for bar SCIAL among bartenders: −0.058 (se: 0.021); 𝑃<0.01
Hahn et al., 2008 [52]	US (BRFSS)	Before/after w/comparison	2001–2005	Adults, age 18+	(I) complete ban, including restaurants and/or bars, 579* and 281**; (C) no smoke-free laws, 6560* and 2993**	Daily or some day smoker and smoked at least 100 cigarettes lifetime	Smoking prevalence 40 months prior to law: (I) 25.7% (95% CI: 21.2, 30.1%); (C) 28.4% (95% CI: 26.8, 30.0); Smoking prevalence 20 months after law: (I) 17.5% (11.8, 23.1); (C) 27.6% (25.2, 30.0); aOR = 0.84 (0.72, 0.97)
Lemstra et al., 2008 [53]	Canada (Canadian Community Health Survey)	Before/after w/comparison	2003–2005	Adults	(I) complete ban, including restaurants and/or bars, 1301* and 1244**; (C1) Saskatchewan; (C2) Canada	NR	Baseline smoking prevalence: (I) 24.1% (95% CI: 20.4, 27.7); (C1) 23.8 (22.6, 25.3); (C2) 22.9 (22.5, 23.3); Smoking prevalence 1 year after law: (I) 18.2% (15.7, 20.9); (C1) 23.8; (C2) 21.3 (20.8, 21.8)
Lee et al., 2011 [61]	England (Health Survey for England)	Before/after w/o comparison	2003–2008	Adults, age 18+	(I) complete ban, including restaurants and/or bars	Current smoker	aOR = 1.02 (95% CI: 0.94, 1.11)
Guerrero et al., 2011 [56]	Spain (National Health Survey for Spain)	Before/after w/o comparison	1993–2009	Adults, age 16–65	(I) complete ban, including restaurants and/or bars^††	Smoked at least 100 cigarettes lifetime	Smoking prevalence in 1993: 36.18%; Smoking prevalence in 2003: 30.97%; Smoking prevalence in 2006 (<1 yr after ban): 29.50%; Smoking prevalence in 2009 (3 yrs after ban): 31.47%
Verdonk-Kleinjan et al., 2011 [64]	The Netherlands (Continuous Survey of Smoking Habits)	Before/after w/o comparison	2003-2004	Adults, age 16–65	(I) complete ban in workplaces, 601	Daily smoking	Smoking prevalence prior to ban: 27.5%; Smoking prevalence 1 month after ban: 25.5%; OR = 0.87 (95% CI: 0.70; 1.08)
Mullally et al.,; 2009 [58]	Ireland (survey commissioned by the Office of Tobacco Control)	Before/after w/o comparison	2004-2005	Adults, age 18+	(I) complete ban, including restaurants and/or bars	Smoked more than 1 cigarette per week	Smoking prevalence prior to law: 28.3%; Smoking prevalence 1 year after law: 24.8%; 𝑃=0.055
Elton and Campbell, 2008 [62]	England (original data collection)	Before/after w/o comparison	2007	Adults, age 18+,; age 18–24: 7%; age 25–34: 12%; age 35–44: 16%; age 45–54: 18%; age 55–64: 20%; age 65–74: 14%; age 75+: 13%; 45% male	(I) complete ban, including restaurants and/or bars, 2054* and 1938**	Currently smoke	Baseline smoking prevalence: 22.4%; Smoking prevalence 3 months after law: 22.6%
Haw and Gruer, 2007 [60]	Scotland (original data collection)	Before/after w/o comparison	2005–2007	Adults, age 16–74	(I) complete ban, including restaurants and/or bars, 1815* and 1834**	Self-reported	Baseline smoking prevalence: 35.6%; Smoking prevalence after law: 35.1%
Galan et al., 2007 [59]	Spain	Before/after w/o comparison	2005-2006	Adults, age 18–64,; Age 18–29: 26%; Age 30–44: 40%; Age 45–64: 33%; 48% male	(I) complete ban, including restaurants and/or bars^††, 1750* and 1252**	Self-reported	Baseline smoking prevalence: 31.7%; Smoking prevalence after law: 32.7%
Gallus et al., 2006 [55]	Italy (DOXA)	Before/after w/o comparison	2004-2005	Adults, age 15+	(I) complete ban, including restaurants and/or bars^†	NR	Baseline smoking prevalence: (I) 26.2%; Smoking prevalence 3 months after laws: (I) 25.6%
Sloan and Trogdon, 2004 [33]	US (BRFSS)	Before/after w/o comparison	1990–2002	Adults, age 18+; 35–46% male	Categorical variables based on number and type of public places where smoking is banned: none, nominal, basic, moderate, and extensive^‡, 1,762,686	Daily or some day smoker	Nominal^‡‡: 0.011, 0.001, −0.001, −0.004, and 0.006; Basic^‡‡: 0.032, −0.047, 0.009, 0.013, and 0.005; Moderate^‡‡: 0.030, −0.015, 0.017, 0.015, and 0.008; Extensive^‡‡: 0.013, −0.011, 0.004, −0.005, and −0.007

*Prelaw sample size.
**Postlaw sample size.
^†Exceptions were made to the smoking ban for restaurants with separate and regulated smoking areas.
^††There was a partial ban on smoking in restaurants and bars. Establishments of less than 100 square meters were able to decide whether or not to permit smoking. Establishments of more than 100 square meters could provide a separate smoking area with a separate ventilation system that was no larger than 30% of the total area of the premises.
^‡Based on data from the State Legislated Actions on Tobacco Issues, 2002.
^‡‡Results reported by age group: 18 to 20 years, 21 to 24 years, 25 to 44 years, 45 to 64 years, and 65 years and older.
^§Based on data from Robert Wood Johnson’s ImpacTeen database.
AAA: Aspirin for Asymptomatic Atherosclerosis; aOR: adjusted odds ratio; BRFSS: Behavioral Risk Factor Surveillance Survey; C: control; CI: confidence interval; CIA: clean indoor air; CO: carbon monoxide; f: females; I: intervention; ITC: International Tobacco Control Policy Evaluation Project; m: males; MACC: Minnesota Adolescent Community Cohort; MCS: Millennium Cohort Study; NR: not reported; ppm: parts per million; SOEP: Socio-Economic Panel Study; TUS-CPS: Tobacco Use Supplement to the Current Population Survey; UK: United Kingdom; US: United States.